The little triangle of gums between your front teeth. Did you ever notice it? Look closely. Between each tooth should be a little triangle of gum called a papillae.
That little tiny triangle of gum is of ultimate importance when having an implant in the front of the mouth.
When you smile big you probably see these triangles. When an implant is ideal it should have a triangle of gum on each side. If it does not, it may look funny. In fact, it may be missing all together leaving a black hole.
There are ways to regenerate these papilla but the best way is to
prevent them from receding. I go through an extensive work up to predict the outcome before surgery ever begins.
The health of your real teeth around the implants is of utmost importance. If the adjacent teeth have even slight bone loss, this could prevent the formation of the papilla or it may not be as big as it is suppose to be.
This triangle of gum should be discussed with you should you elect to have implants for the front teeth. It is especially important if there are multiple dental implants next to each other.
The following pictures show what I call cosmetic failures. I did NOT treat these patients. These are dental implants that do not have the papillae:
These pictures are samples of my work:
Although this little tiny triangle of gum may be insignificant to you now, it is of paramount importance to me. It makes all the difference!
Let me know if I can help avoid this problem!
Hello Dr Amin
I am a 22 yr old female. I have lost my 4 upper front teeth after an accident and plan on getting two implants with a bridge.
My problem is that my gum line is uneven, even though before the accident very little gum would show when I smile I still feel that it made a difference and I feel uncomfortable smiling now.
My dentist said that due to my gum being thin a gum graft may be unsuccessful. Pink porcelain over crowns was suggested.
I would be grateful if you can make any recommendations.
Regards
Hi Sara,
I know how you feel.
A gum graft will almost ALWAYS help thin gums but MAY not put the “triangle” back. Do you have any pictures of you in a full, big smile that you can email me?
That will really help me to give you a better idea. Do you live nearby?
Dr. Ramsey Amin
Hello Dr. Amin,
Thank you for your reply.
Unfortunately, I do not live nearby. I can definitely e-mail you pictures before and after the accident.
Can you please let me know on which e-mail I can send them.
In the upper right is an “Email Me” link.
Go ahead and send it to me there.
Dr. Amin
Excellent post on the issue. I have also seen very few people care about Triangle of Gums Between Teeth and Implants. Thanks for this nice concern.
Hello Dr Amin,
I just came back from my periodontist in tears because this is going to be an issue with my implants.
You see, I was born without my lateral incisors and as a result my adult cuspids grew-in in their places. So, 2 years ago, he referred me to an orthodontist. I had my primary incisors pulled and the braces have been moving the cuspids over about 6.5mm to make room to implant the lateral incisors.
Today he tells me that my teeth are triangular and my gum has flattened next to my central incisors and that my options are to graft the gum, pull my central incisors down (which will in turn pull “a bit” of gum down), or square off my central incisors.
I’ve finally stopped crying and don’t know what to do. I’m not too keen on them pulling my front teeth down as I fear this may create MORE problems.
I would be grateful if you can make any recommendations.
Thank you.
Hi Keyro,
Do you show your gums when you smile big?
Dear Doc.,
I just got done with my Orthodontic treatment. Now my teeth are nice and aligned, and my smile never looked better. The only problem is the small triangles between the teeth and gums. I find that this is the place where the food particles get stuck, etc. Also having these triangles filled would make my smile even better.
Is is possible? If Yes, what would be the costs involved as a rough ball park estimate?
Thanks,
Ro.
Hi Ro,
Are you an adult or a teen? Do you have any bone loss from gum disease even if it is slight?
Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow of the American Academy of Implant Dentistry
Burbank, California
Voted Best Dentist in Burbank -2006, 2008, 2010, 2011
http://www.burbankdentalimplants.com
Thanks for the reply Dr. Amin.
I’m 27. I’m not quite sure but I think I might have a slight bone loss.
I am curious to know your opinion.
Thanks.
Hi Ro,
If you have all of your teeth (no implants) then the slight bone loss is more than likely causing this. Often, veneers or bonding are used to fill the spaces if it is truly due to bone loss.
It would be best to get into the hands of someone in your area to evaluate and diagnose the problem then discuss treatment. Are you local to southern California?
Dr. Amin
I do have all my teeth. Sorry I live in Texas. I guess I will visit a dentist to see what options do I have.
Thanks for the advice.
Dear Dr.Armin
I have a question regarding your column. I had done my Orthodontic treatment for year and a half. I started to notice my papillae are missing about half a year. But I didn’t really care about them until recently. I am not sure when it started missing actually, maybe even before I’m done with the Orthodontic treatment? Could the treatment be the cause?
Right now I have few places of papillae missing, they’re not major yet. Noticeable if look closely. I am afraid that it’s going to get worse. Would it get better if I keep my teeth clean and healthy, or at least not getting worse?
Thanks for your comment in advance,
Hi Chatdanai,
The most likely scenario is you have some degree of pre-existing bone loss between youor teeth. The bone crest between each tooth supports the gum triangle. Now that the teeth have moved from being crooked, the black triangles show because the teeth don’t overlap.
Are you over 35 years old?
Ramsey A. Amin, D.D.S., D.A.B.O.I.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry
UCLA and Western U. Dental School Faculty
Hi Dr.Amin
Thank you for your reply.
No I am about to turn 24 this year.
I am still thinking that it maybe the side-effect of my Orthodontic treatment. I am also having gum receding on my mandible. I am worrying that it’s going to cause sensitivity and so on.
Is it normal after Orthodontic treatment to have this problem? Do you have any suggestion on my case?
Thank you,
Speak to your dentist asap. Without seeing you, I cant tell you exactly what the issue is.
Sorry!!
Dr. Ramsey Amin
Yes sir.
Thank you for your time and advice.
Dr. Amin,
I have a space between my lower front teeth and I’ve noticed that the pink triangle between them has disappeared. Both teeth look quite long. I thought that I could possibly have a gum graft but it seems that I need papilla to have any chance of success. I’ve just recently set my mind towards investing in orthodontic treatments to correct my teeth. Is it too late for that?
Dental implants and teeth can have space that results in a black triangle. This is usually due to bone loss. Since you don’t have an implant, you should consult with your dentist.
My special training is in implant dentistry not in orthodontics.
Respectfully,
Dr. Amin
It is never to late for orthodontics. It always helps!
Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry
the triangle of my gums is loose, and may fall off! it is not firm between my teeth but outside, what should i do?
Is this on an implant or on a tooth?
Dr. Amin
Definitely see a dentist ASAP.
Dr.Amin,
I am 13 years old and just got my braces off. I noticed that on my bottom 2 middle teeth the gum part is missing and is leaving a black whole. I asked my orthodontist about it, and he said that it would grow back. I am very concerned and your repy would be greatly appreciated.
Hi Brin,
At your age the hole should fill in
Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry
Burbank, California
What about if i am a 19 year old who just removed his braces 19 year old this year. Can my one and only small black hole between 2 teeth be filled naturally by my gum tissue?
Hi Samuel,
It is likely that in your situation it will fill in automatically! Good luck!
Dr. Amin
I just recently had jaw surgery and my mouth is wired shut. Since its wired shut I can only eat liquid foods. I blend all my meals and will be doing so for 4 weeks until i get the wires removed. Since I can’t open my mouth to eat, anytime im eating im sucking in the liquid food. I noticed that the gum in between my 2 front teeth is missing now and i think its due to all the “sucking”. Theres a black hole instead of gum that i never noticed before. I can also tell that this is new because there is a slight burning sensation around that area as if there is damage to the gums. Will this grow back? if not how can i get it back??
Hi Adrian,
The broken jaw is no fun. It sounds like you had a bad break to have to be wired shut instead of plating the fracture.
Keep your gums as healthy and clean as you can while the arch bars are on. If your teeth were really healthy before the fracture, the triangle will likely recover.
Hang in there!
Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry
Burbank, California
DEAR DR. AMIN,
I JUST HAD IMPLANT ON TOOTH #7. I HAD A STITCH AND SOME ADDED BONE. I WENT TO A GUM AND IMPLANT SPECIALIST. I LIVE IN FLORIDA. i HAD IT DONE THIS MARCH 6TH AND HAVE A FOLLOW UP ON MARCH 14TH. I HAVE A LOT OF PRESSURE ON THE IMPLANT TOOTH AS WELL AS #8 TOOTH ,WHICH WAS PERFECTLY FINE. THEY BOTH FEEL FAKE ,THER E IS A BLUGE INBETWEEN THE IMPANT AND NATURAL TOOTH. WILL THIS BE THERE FOR EVER OR WILL IT HEAL . I AM VERY UPSET. PLEASE LET ME KNOW WHAT YOU THINK. THANK YOU, SANDY
Hi Sandy,
Is the triangle of gum missing now? Is your pain absent now?
Respectfully,
Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry
Dr Amin
I needed two root canals and two crowns on teeth 29 & 30,my question is my dentist lasered off my interdental papillas completely between teeth #29 & #30 and on the other side of tooth #30,on tooth #30 she did have to do crown lengthening,why would she have lasered off my papillas when she never worked under the gums beneath the papilla area,I now have a large triangle gap between my crowns,that she states will grow back, the papillas are not growing
I feel my dentist lasered my papillas off two get them out of the way so she could work on the post for the teeth
Hi Russell,
The triangle of gum between natural teeth and implants are COMPLETELY different. If the bone is healthy, they will likely grow back. It sounds like you had some deep pockets, so the dentist is helping you to keep these compromised teeth. If you have none loss, they won’t fully grow back, but you are more likely to keep the teeth.
Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry
Recently I underwent through Flap Surgery. Because of the severe Bone loss my 4 Upper front teeth are in very bad condition and the bone loss is reached almost 80- 95 percent. Two teeth are removed at present and they are fixed temporarily, while RC has been done for the other two. My doctor has recommended to go for a bridge of 6 teeth with the support of canine. Can you please suggest in this context.
Hi Raj,
You can rebuild the bone in the area of the four front teeth and not grind down the natural teeth for a bridge. The bridge will be replaced every 5-15 years, even if it is well done.
Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry